Smile Squad Registration Form

Contact Information

First Name *
Last Name *
Phone *
Email *

Shipping Address
(where you would like the books and toothbrush kits sent)

Address *
City *
State *
Zip *

The free patch program for Girl Scouts is currently only available to girls in the Girl Scouts of Silver Sage Council.

Troop Information

Council *
v
Troop Number *

Please indicate the number of scouts in your troop:

Daisies:
Brownies:
Juniors:
Cadettes:
Seniors/Ambassadors:
Total Number of Girls:
Submit

Questions?

If you have questions, need assistance, or are interested in receiving information about the Delta Dental of Idaho's oral health programs and activities, please contact Community Outreach at co.gsss@deltadentalid.com.